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IDS > Tetanus > Flashcards

Tetanus Flashcards

1
Q

Factors Associated with a Poor Prognosis in Tetanus

A
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2
Q

Clinical and pathologic progression of tetanus.

A
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3
Q

It is caused by a powerful neurotoxin produced by the bacterium Clostridium tetani and is completely preventable by vaccination

A

Tetanus

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4
Q

When does Tetanus commonly occur?

A

low vaccination coverage rates

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4
Q

How is Tetanus diagnosed?

A

Clinical

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5
Q

What is the CDC’s definition of probable Tetanus?

A

An acute illness with muscle spasms or hypertonia without a more likely diagnosis.

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6
Q

It is defined by the World Health Organization (WHO) as “an illness occurring in a child who has the normal ability to suck and cry in the first 2 days of life but who loses this ability between days 3 and 28 of life and becomes rigid and has spasms.

A

Neonatal tetanus

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7
Q

It s defined by the WHO as tetanus occurring during pregnancy or within 6 weeks after the conclusion of pregnancy (whether with birth, miscarriage, or abortion).

A

Maternal tetanus

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8
Q

An anaerobic, gram-positive, spore-forming rod whose spores are highly resilient and can survive readily in the environment throughout the world

A

C. tetani

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9
Q

Spores resist boiling and many disinfectants T/F

A

T

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10
Q

What infections are associated with more severe tetanus?

A

Deeper infections such as those due to open fracture, abortion, or drug injection.

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11
Q

Only bacteria producing tetanus toxin (tetanospasmin) can cause tetanus. T/F

A

T

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12
Q

What happens after the tetanus toxin binds to nerve terminals?

A

The toxin is internalized and undergoes retrograde transport to the motor neuron body.

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13
Q

What happens to tetanus toxin after retrograde transport?

A

After retrograde transport in the motor neuron, tetanus toxin translocates across the synapse to GABA-ergic presynaptic inhibitory interneuron terminals.

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14
Q

What role does the light chain of tetanus toxin play?

A

The light chain, a zinc-dependent endopeptidase, cleaves VAMP2 (vesicle-associated membrane protein 2), necessary for neurotransmitter release.

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15
Q

What is the effect of tetanus toxin on neurotransmitter release?

A

It prevents the release of neurotransmitter, blocking inhibitory interneuron discharge, leading to unregulated activity in the motor nervous system.

16
Q

The most common initial symptoms are

A

trismus (lockjaw), muscle pain and stiffness, back pain, and difficulty swallowing

17
Q

The clinical manifestations of tetanus occur only after tetanus toxin has reached ______

A

presynaptic inhibitory nerves

18
Q

What happens during the second week of severe tetanus?

A

Autonomic disturbance peaks, with cardiovascular events becoming the major risk

19
Q

What are signs of autonomic involvement in tetanus?

A

Signs include labile blood pressure, tachycardia, bradycardia, heart block, gastrointestinal stasis, sweating, increased tracheal secretions, and acute renal failure.

20
Q

What is the preferred antibiotic therapy for tetanus?

A

Metronidazole (400 mg rectally or 500 mg IV every 6 hours for 7 days) is preferred.

21
Q

What is an alternative to Metronidazole for tetanus treatment?

A

An alternative is penicillin (100,000–200,000 IU/kg per day), though it may exacerbate spasms and was associated with increased mortality in one study.

22
Q

It is given early in an attempt to deactivate any circulating tetanus toxin and prevent its uptake into the nervous system

A

Antitoxin: TIG/Equine antitoxin

23
Q

The preparation of choice for antitoxin, as it is less likely to be associated with anaphylactoid reactions

A

TIG

24
Q

How are spasms controlled

A

benzodiazepines

25
Q

What environment is ideal for tetanus patients?

A

calm, quiet environments to avoid triggering spasms

26
Q

How long can recovery from tetanus take?

A

4–6 weeks

27
Q

Patients must be given a full primary course of immunization as tetanus toxin is poorly immunogenic and the immune response following natural infection is inadequate. T/F

A

T

28
Q

What are the catch-up schedules for incomplete primary vaccination in infancy?

A

For those age 7 years or older, the recommendation is a three-dose primary course with 4 weeks between the first two doses, followed by a booster 6–12 months later.

29
Q

What are WHO recommendations for maternal and neonatal tetanus prevention?

A

2 doses of tetanus toxoid at least 4 weeks apart to previously unimmunized pregnant women.
A third dose should be given at least 6 months later, followed by one dose in subsequent pregnancies (or intervals of at least 1 year), to a total of five doses to provide long-term immunity.

30
Q

What is the recommended airway management method for patients with severe tetanus requiring prolonged ventilation? A. Nasal oxygen
B. Endotracheal intubation
C. Tracheostomy
D. Non-invasive positive pressure ventilation (NIPPV)
Answer: C. Tracheostomy

A

They should undergo passive immunization with TIG.

31
Q

What is the role of intravenous magnesium sulfate in the treatment of severe tetanus? A. It increases blood pressure
B. It acts as a muscle relaxant and helps control spasms
C. It serves as an antibiotic
D. It stimulates immune function

A

B

31
Q

Which of the following measures is most effective for controlling spasms in severe tetanus? A. High-dose aspirin
B. Benzodiazepines
C. Low-dose ibuprofen
D. Oral antibiotics

A

B

32
Q

What is the recommended course of action if a tetanus patient has an incomplete vaccination history and presents with a non-clean wound? A. Administer oral antibiotics only
B. Passive immunization with tetanus immune globulin (TIG)
C. Wait for culture results before starting treatment
D. Prescribe vitamin supplements

A

B

33
Q

What serum anti-tetanus immunoglobulin G level is considered protective against tetanus? A. >0.01 IU/mL
B. >0.05 IU/mL
C. >0.1 IU/mL
D. >1.0 IU/mL

A

C

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